Provider Demographics
NPI:1316948045
Name:GURKA, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:GURKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1015
Mailing Address - Country:US
Mailing Address - Phone:781-648-2540
Mailing Address - Fax:781-641-9844
Practice Address - Street 1:63 MASS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8612
Practice Address - Country:US
Practice Address - Phone:781-648-2540
Practice Address - Fax:781-641-9844
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50276207K00000X
MA5076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A57112Medicare UPIN
MAJ03684Medicare ID - Type Unspecified